Surgical treatment of mandibular osteoradionecrosis: versatility of the scapular osteocutaneous flap.

Osteoradionecrosis of the mandible is a serious complication of radiotherapy for head and neck cancer and no single treatment has to date met with consistent success. A free scapular osteocutaneous flap was successfully transferred in nine patients with mandibular osteoradionecrosis who before this had not responded to conservative treatment. All but one of the patients had good bone union and there was no evidence of recurrence during a mean follow up period of four years and one month. This flap not only provides a well-vascularised segment of the bone but also multiple, large skin paddles, each with an abundant and reliable blood supply. In addition, well-vascularised fascia and overlying subcutaneous tissue can be used to fill dead spaces and cover the bony segment and fixation plates. This reduces postoperative infection and promotes primary wound healing. This flap has proved useful for reconstruction of mandibular osteoradionecrosis, particularly when there is a large soft tissue defect.